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Title 42

Displaying title 42, up to date as of 7/16/2026. Title 42 was last amended 7/01/2026.
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Title 42Public HealthPart / Section
Chapter IVCenters for Medicare & Medicaid Services, Department of Health and Human Services400 – 699
Subchapter CMedical Assistance Programs430 – 456
Part 456Utilization Control456.1 – 456.725
Subpart AGeneral Provisions456.1 – 456.6
§ 456.1Basis and purpose of part.
§ 456.2State plan requirements.
§ 456.3Statewide surveillance and utilization control program.
§ 456.4Responsibility for monitoring the utilization control program.
§ 456.5Evaluation criteria.
§ 456.6Review by State medical agency of appropriateness and quality of services.
Subpart BUtilization Control: All Medicaid Services456.21 – 456.23
§ 456.21Scope.
§ 456.22Sample basis evaluation of services.
§ 456.23Post-payment review process.
Subpart CUtilization Control: Hospitals456.50 – 456.145
Subpart DUtilization Control: Mental Hospitals456.150 – 456.245
Subpart E [Reserved]
Subpart FUtilization Control: Intermediate Care Facilities456.350 – 456.438
Subpart GInpatient Psychiatric Services for Individuals Under Age 21: Admission and Plan of Care Requirements456.480 – 456.482
§ 456.480Scope.
§ 456.481Admission certification and plan of care.
§ 456.482Medical, psychiatric, and social evaluations.
Subpart HUtilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals456.500 – 456.525
Subpart IInspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases456.600 – 456.614
Subpart JPenalty for Failure To Make a Satisfactory Showing of an Effective Institutional Utilization Control Program456.650 – 456.657
Subpart KDrug Use Review (DUR) Program and Electronic Claims Management System for Outpatient Drug Claims456.700 – 456.725